ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
Objective To analyze the value of serum levels of miR-141-3p, miR-130a, miR-29a-3p, and miR-210 in predicting early neurological deterioration (END) in non-traumatic intracerebral hemorrhage. Methods The patients with non-traumatic cerebral hemorrhage who met the selection criteria and were admitted to Chengde Central Hospital between February 2021 and October 2022 were prospectively selected by convenience sampling method. The serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels upon admission and the occurrence of neurological deterioration within 24 h were collected, and the patients were divided into a deterioration group and a non-deterioration group according to whether neurological deterioration occurred. The correlation of serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels with the END of non-traumatic intracerebral hemorrhage and their predictive value to the END of non-traumatic intracerebral hemorrhage were analyzed. Results A total of 235 patient were enrolled. Of the 235 patients, 45 (19.1%) showed neurological deterioration and 190 (80.9%) showed no neurological deterioration. The levels of miR-141-3p and miR-29a-3p in the deteriorating group were significantly lower than those in the non-deteriorating group [(1.11±0.32) vs. (1.76±0.51) ng/mL, P<0.001; (1.19±0.31) vs. (1.71±0.51) ng/mL, P<0.001], and the levels of miR-130a and miR-210 were significantly higher than those in the non-deteriorating group [(5.13±1.11) vs. (3.82±1.03) ng/mL, P<0.001; (3.96±0.76) vs. (2.78±0.50) ng/mL, P<0.001]. Multivariate logistic regression analysis showed that serum miR-141-3p and miR-29a-3p levels were protective factors for the occurrence of END in non-traumatic intracerebral hemorrhage patients [odds ratio (OR)=0.513, 95% confidence interval (CI) (0.330, 0.798), P=0.003; OR=0.582, 95%CI (0.380, 0.893), P=0.013], and serum miR-130a and miR-210 levels were independent risk factors for that [OR=2.046, 95%CI (1.222, 3.426), P=0.007; OR=2.377, 95%CI (1.219, 4.638), P=0.011]. The area under the receiver operating characteristic curve was 0.857 [95%CI (0.760, 0.954)] in predicting the END of non-traumatic intracerebral hemorrhage by the combined probability of the serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 levels obtained by logistic regression, and the sensitivity was 86.7%, the specificity was 94.7%, the positive predictive value was 79.6%, and the negative predictive value was 96.8% according to the cut-off value of the prediction probability of the combined test. Conclusion The combined detection of serum miR-141-3p, miR-130a, miR-29a-3p, and miR-210 has a high predictive value in the occurrence of END in non-traumatic intracerebral hemorrhage patients.
This study was aimed to improve the sensitivity of magnetic induction phase shift detection system for cerebral hemorrhage. In the study, a cerebral hemorrhage model with 13 rabbits was established by injection of autologous blood and the cerebral hemorrhage was detected by utilizing magnetic induction phase shift spectroscopy (MIPSS) detection method under the feature band. Sixty five groups of phase shift spectroscopy data were obtained. According to the characteristics of cerebral hemorrhage phase shift spectroscopy under the feature band, an effective method, B-F distribution, to diagnose the severity of cerebral hemorrhage was designed. The results showed that using MIPSS detection method under feature band, the phase shift obviously growed with increase of injection volume of autologous blood, and the phase shift induced by a 3-mL injection reached-7.750 3°±1.420 4°. B-F distribution could effectively diagnose the severity of cerebral hemorrhage. It can be concluded that the sensitivity of the cerebral hemorrhage magnetic induction detection system is improved by one order of magnitude with the MIPSS detection method under the feature band.
ObjectiveTo study the brain tissue oxygen and prognosis index of the postoperative patients with hypertensive intracerebral hemorrhage (HICH) associated with secondary brain insults. MethodsA total of 120 patients with HICH from January 2006 to June 2013 were treated by neurosurgical intervention. Postoperative monitoring of factors affecting the secondary brain insults in the 120 patients and of brain tissue oxygen in 10 patients was performed and statistically analysis was carried out. ResultsSecondary brain insults had a significant influence on the prognosis of postoperative patients with hypertensive intracerebral hemorrhage, and was correlated with brain tissue oxygen metabolism. ConclusionAbnormal secondary brain insults affect brain tissue oxygen metabolism, which may further deteriorate the brain damage and can lead to poor prognosis.
Resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) is still a dilemma to clinical decision. To date, no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC. In recent years, some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality, without significantly increasing the risk of ICH; it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH; new OACs are superior to vitamin K antagonists; patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH, otherwise, a time-window for optimal resumption is between 4-8 weeks; meanwhile, individual patient characteristics should be considered and blood pressure should be strictly controlled.
ObjectiveTo explore the advantages and operation skills of ultra-early small bone window craniotomy surgery on cerebral hemorrhage in basal ganglia regions. MethodsWe retrospectively analyzed the clinical data of 58 patients with cerebral hemorrhage in basal ganglia regions who underwent ultra-early small bone window craniotomy between January 2009 and December 2012. ResultsPatients within 24 hours after surgery were re-checked by CT scan, which showed that hematoma was cleared in 53 cases, most removed in 2 cases, re-hemorrhage occurred in 2 patients whose hematoma was immediately removed by the original incision, 1 patient had large area infarction and underwent bone flap decompression. According to Glasgow outcome scale score at discharge, the outcome was good in 23, moderate disability in 18, severe disability in 12, persistent vegetative state in 2 and 3 were dead. ConclusionUltra-early skull-window craniotomy can timely and completely remove the hematoma, provide reliable coagulation, protect important arteries with less re-hemorrhage and excellent outcome, which is one of the most effective methods for treating cerebral hemorrhage in basal ganglia regions.
The incidence, mortality, and disability rate of spontaneous intracerebral hemorrhage (SICH) are high, and its surgical and medical treatment is still controversial. With the development of micro-neurosurgical technology, minimally invasive surgery (MIS) has made great progress in the treatment of SICH. It can remove intracerebral hematoma in the early stage after SICH and minimize or eliminate secondary brain injury, which is of great significance to reducing the mortality and disability rate. For many years, due to its continuous progress, MIS has been more and more widely used in the treatment of SICH. This article mainly reviews the progress of MIS in SICH and related clinical research at home and abroad, and briefly describes several innovative techniques related to MIS, which aims to promote the exchange of clinical experience in MIS of SICH.
Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.
Stroke with hereditary cerebral small vessel diseases is a rare disease. Its clinical manifestations include early-onset ischemic lacunar or hemorrhagic stroke with high disability. Its typical imaging markers include lacunes, white matter hyperintensities, microbleeds, intracerebral hemorrhages located in deep or lobe of brain, crotical microinfarcts, and enlarged perivascular spaces. As the clinical and neuroimaging signs and symptoms of hereditary cerebral small vessel diseases often overlap with sporadic cerebral small vessel diseases, it is hard to diagnose. This article summarizes the clinical features, importance of obtaining valuable family history, genetic diagnosis, and management of stroke with hereditary cerebral small vessel disease to improve its accuracy diagnosis.
ObjectivesTo explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.MethodsA total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.ResultsThe operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.ConclusionsCompared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.